Cultural roadblocks may impede early diagnosis of Alzheimer’s

Recent research findings have pointed the way to earlier diagnosis and better treatment of Alzheimer’s disease (AD), but cultural views may cause delays for patients and their families seeking professional help.

“Often when the family knows that a member has dementia or AD, they deny the issue. (It is) a combination of shame and fear and a language barrier, which does not allow them to seek assistance,” says Vivian Lam, support education coordinator for the two Chinese Resource Centers of B.C.’s Alzheimer’s Society.

developing the Cognitive Testing on Computer (C-TOC), one of her diagnostic tools. Designed to be self-administered, C-TOC is a computer program which includes tests of memory, language, attention and visuo-spatial abilities.

“When we developed C-TOC, we asked a panel of health professionals – nurses, social workers, immigration workers- from South East Asian, Chinese, Latin American, Middle Eastern and Japanese communities: ‘Would people consult a doctor if they experience memory loss?’ In general, all panelists responded that people from their communities would feel too much shame and therefore unwillingness to express memory loss in the presence of the family members. But there are differences between ethno-cultural groups. We found that the Chinese and Japanese communities were more willing to speak to a doctor of their own (ethnic) community,” Jacova says.

Lam, who oversees the delivery of educational and support programs for patients and their caregivers in the Chinese community, suggests that within this group patients usually go to a Chinese physician who tells the family that the symptoms are ‘old age’.

“(The) family physician is not diagnosing (AD) early enough,” says Lam.

The Alzheimer’s Foundation of Canada describes AD as not a normal part of aging, but a progressive, degenerative disorder that attacks the brain’s nerve cells, resulting in loss of memory, thinking and language skills and behavioral changes. About 450,000 Canadians are affected by AD, a number that could rise to more than 750,000 by 2031 according to the foundation’s projections.

Clinicians can diagnose probable presence of AD via physical exams, health history, lab tests and brain scans, but AD can only be confirmed via a brain autopsy. There is currently no cure for AD, though recent scientific findings are promising, including a new stem cell technique developed by researchers at the New York Stem Cell Foundation (NYSCF).

“(T)he clinically relevant aspect of this study would be its power in modeling patient-specific disease pathologies more accurately, which is what we can do right now,” says David McKeon, chief of staff at NYSCF. “[The team] led by Dr. Scott Noggle and Dr. Michael W. Nestor took skin cells and, through a technique called ‘reprogramming,’ transformed these cells back into an embryonic-like state. In other words, you can observe at the cellular level a disease playing out in a dish, a so-called ‘disease in a dish’ model. This is incredibly powerful as it enables scientists to streamline their disease investigations and tailor treatments to all different types of patients.”

Dr. Dara Dickstein

Research is also advancing on vaccines that may be able to delay the onset of AD. Last month, in the journal Scientific Report,

Wilfred Jefferies, a professor at UBC’s Michael Smith Laboratories, and his team reported having found a vaccine that successfully reduces the number of capillaries and the amount of harmful plaque and proteins in the brains of mice with AD.

“Vaccination reduces the aggregation of the protein amyloid beta, reduces inflammation and reverses hypervacularization in the brain,” says team member Dara Dickstein, assistant professor in the departments of neuroscience, geriatrics and palliative medicine at the Icahn School of Medicine of Mount Sinai Hospital in New York. “We know vaccine equals prevention, but we are not at that stage yet in AD patients. First, we need to have a diagnostic biomarker, and most importantly, we need to be able to diagnose early.”